138-LB: Managing Hyperglycemia in Patients on an Insulin Pump: A Quality Improvement Study

Abstract

During the transition from multiple daily injections to an insulin pump, diabetic patients need to engage in an intense period of learning to operate their pumps successfully. Inpatient endocrinology consultants note that some new users of insulin pumps fail to manage hyperglycemia correctly and present to the hospital in diabetic ketoacidosis. We found these patients often did not know when to use manual injections instead of their pumps or did not have backup insulin pens or syringes at home. To better understand this issue, a baseline survey of diabetic patients on insulin pumps was conducted from February to September 2020. The survey was administered to 52 subjects identified though appointments scheduled with the diabetes clinic. The questionnaire asked: 1) How would you respond if your sugar remained elevated an hour after administering a correction bolus through the pump? 2) Do you have insulin syringes or pens at home? The first question reflects events that would occur in the setting of an insulin pump failure. Any response that did not include a manual injection was considered incorrect. Our data showed that 85% of respondents had backup insulin supplies. 33% of patients overall responded appropriately to the pump failure scenario. Of the subjects who had insulin supplies, 39% responded correctly. Further analyses revealed that there is a significant relationship between having supplies and responding appropriately to hyperglycemia in pump failure. There was no relationship between patients’ answers and gender or age. Results of this survey will be used to modify the electronic template for diabetes clinic visits in order to help ensure that patients have appropriate supplies and training in identifying pump malfunctions and handling hyperglycemia. As part of this quality improvement project, patients will be surveyed again after implementation of the new template to assess whether the rates of possessing backup insulin supplies and of appropriate responses to hyperglycemia increased. Disclosure A. Yuen: None. V. Tabatabaie: None.